VA FORM APR 2020 20-10207

PRIORITY PROCESSING REQUEST INSTRUCTIONSPlease complete the attached form to submit a request for priority processing of a claim due to certain circumstances or status as described below along with any supporting information or evidence.

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WHERE TO SEND INFORMATION AND EVIDENCE:

If you are… Then submit the following evidence if available or not already on file with VA…

• Experiencing extreme financial hardship

Documentation showing extreme financial hardship, including but not limited to the following: • Copy of an eviction notice or statement of foreclosure • Copy of notices of past-due utility bills • Copy of collection notices from creditors

• Terminally ill

• Diagnosed with Amyotrophic Lateral Sclerosis (ALS) also known as Lou Gehrig's disease

• Very Seriously Injured/Ill or Seriously Injured/Ill during military operations (Defined as a disability resulting from a military operation that will likely result in discharge from military service.)

• Age 85 or older • Date of birth

• Former Prisoner of War • Copy of military personnel records such as DD Form 214, Certificate of Release or Discharge from Active Duty, or

• Information such as service number, branch and dates of service, dates and location of internment, detaining power, or any other information relevant to the detainment

• Medal of Honor or Purple Heart Award recipient

• Copy of military personnel records such as DD Form 214, or • Information showing receipt of Medal of Honor or Purple Heart Award

The time it takes your response to reach VA affects how long it takes us to process your request. We recommend calling our National Call Center at 1-800-827-1000 for immediate assistance whenever possible. If you are not a claimant or representative, we recommend faxing rather than mailing the information to expedite processing. Note: You may designate one person or organization as a third-party representative to act on your behalf.  A third-party may be a family member or other designated person who is not a Power of Attorney (POA), agent, or fiduciary.  If you designate a third-party to represent you, a VA Form 21-0845, Authorization to Disclose Personal Information to a Third-Party, must be attached or of record.

• Copy of military personnel records, such as a determination from the Department of Defense (DOD), and

• Medical evidence showing severe disability or injury, and/or • If you want VA to get your private treatment records, submit a completed VA Form 21-4142

and VA Form 21-4142a

• Copy of medical evidence showing illness that is terminal in nature, and/or

• If you want VA to get your private treatment records, submit a completed VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs, and VA Form 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs. NOTE: VA Forms are available at: www.va.gov/vaforms

• Copy of medical evidence showing ALS also known as Lou Gehrig's disease diagnosis, and/or

• If you want VA to get your private treatment records, submit a completed VA Form 21-4142 and VA Form 21-4142a

Compensation Claims Toll Free: 1-844-531-7818

FAXING:

The fastest way to respond to VA is to contact us at 1-800-827-1000. If you need to fax or mail your correspondence, identify the benefit type; then, use the corresponding fax number or mailing address below:

Board of Veterans' Appeals Toll Free: 1-844-678-8979

Pension & Survivors Benefit Claims Toll Free: 1-844-655-1604

Fiduciary Toll Free: 1-888-581-6826

MAILING ADDRESSES

Compensation Claims Department of Veterans Affairs

Compensation Intake Center P.O. Box 4444

Janesville, WI 53547-4444

Pension & Survivors Benefit Claims Department of Veterans Affairs

Pension Intake Center P.O. Box 5365

Janesville, WI 53547-5365

Board of Veterans' Appeals Department of Veterans Affairs

Board of Veterans' Appeals P.O. Box 27063

Washington, DC 20038

Fiduciary Department of Veterans Affairs

Fiduciary Intake Center P.O. Box 5211

Janesville, WI 53547-5211

These addresses serve all United States and foreign locations.

Attention: If you are currently receiving GI Bill Education benefits and are experiencing any of the reasons listed within Section III: Reason(s) for Request, please call the 1-888-GIBILL1 (1-888-442-4551) or send an email through Ask A Question at www.gibill.va.gov for immediate assistance.

IMPORTANT

If you or someone you know is in crisis, call the Veterans Crisis Line at 1-800-273-8255 and press 1,

or visit https://www.VeteransCrisis/line.net/ to chat online, or send a text message to 838255

to receive confidential support 24 hours a day, 7 days a week, 365 days a year.

Support for deaf and hard of hearing individuals is available.

VA FORM APR 2020 20-10207 PAGE 2

PRIORITY PROCESSING REQUEST

VA FORM APR 2020 20-10207

INSTRUCTIONS: Before completing this form, read the Privacy Act and Respondent Burden on page 5. Use this

form to request priority processing of a claim due to certain status or circumstances. For more information, contact

us at https://iris.custhelp.va.gov, or call us toll-free at 1-800-827-1000. If you use a Telecommunications Device

for the Deaf (TDD), the Federal relay number is 711. VA forms are available at www.va.gov/vaforms.

(DO NOT WRITE IN THIS SPACE) (VA DATE STAMP)

OMB Approved No. 2900-0877 Respondent Burden: 7 Minutes Expiration Date: 07/31/2020

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SECTION I - VETERAN'S IDENTIFICATION INFORMATION (This information is required to process your request)

NOTE: You can either complete the form on-line or by hand. If completed by hand, print the information requested in ink, neatly, and legibly and completely fill in each circle to expedite processing of the form.

8. E-MAIL ADDRESS 

3. DATE OF BIRTH (MM-DD-YYYY)

4. VA FILE NUMBER (If applicable)

2. SOCIAL SECURITY NUMBER

1. VETERAN'S NAME (First, Middle Initial, Last)

7. TELEPHONE NUMBER (Include Area Code)

Enter International Phone Number (If applicable)

SECTION II - CLAIMANT'S IDENTIFICATION INFORMATION (If other than Veteran)

ZIP Code/Postal Code Country State/Province

City Apt./Unit Number

No. & Street

6. CURRENT MAILING ADDRESS (Number and street or rural route, P.O. Box, City, State, ZIP Code and Country)

15. E-MAIL ADDRESS 

12. DATE OF BIRTH (MM-DD-YYYY)11. VA FILE NUMBER (If applicable)10. SOCIAL SECURITY NUMBER

9. CLAIMANTS NAME (First, Middle Initial, Last)

14. TELEPHONE NUMBER (Include Area Code)

Enter International Phone Number (If applicable)

ZIP Code/Postal Code Country State/Province

City Apt./Unit Number

No. & Street

13. CURRENT MAILING ADDRESS (Number and street or rural route, P.O. Box, City, State, ZIP Code and Country)

SECTION III - REASON(S) FOR REQUEST (This information is required in order to complete your request)

16. HOMELESS INFORMATION (Check all that apply) 16A. ARE YOU CURRENTLY HOMELESS?

YES (If "YES," complete item 16B regarding your living situation)

NO (If "NO," skip to item 16C)

16B. CHECK THE BOX THAT APPLIES TO YOUR LIVING SITUATION

LIVING IN A HOMELESS SHELTER16A. ARE YOU CURRENTLY HOMELESS? Radio button. YES

STAYING WITH ANOTHER PERSON

NOT CURRENTLY IN A SHELTERED ENVIRONMENT (e.g. living in a car or tent)

OTHER (Specify)

I agree to receive electronic correspondence from VA in regards to my claim.

I agree to receive electronic correspondence from VA in regards to my claim.

5. INSURANCE NUMBER (If applicable)

VA Form 20-10207, APR 2020 PAGE 4

16C. ARE YOU CURRENTLY AT RISK OF BECOMING HOMELESS?

YES (If "YES," complete item 16D regarding your living situation)

NO (If "NO," skip to item 17)

OTHER (Specify)

LEAVING PUBLICLY FUNDED SYSTEM OF CARE IN 30 DAYS OR LESS (e.g. homeless shelter)

HOUSING WILL BE LOST IN 30 DAYS

16D. CHECK THE BOX THAT APPLIES TO YOUR LIVING SITUATION

17. OTHER REASON(S)/CIRCUMSTANCES FOR REQUEST (Check all that apply)

MEDAL OF HONOR/PURPLE HEART RECIPIENTTERMINALLY ILLEXPERIENCING EXTREME FINANCIAL HARDSHIP

DIAGNOSED WITH AMYOTROPHIC LATERAL SCLEROSIS (ALS) ALSO KNOWN AS LOU GEHRIG'S DISEASE 85 YEARS OF AGE OR OLDER

VERY SERIOUSLY INJURED/ILL OR SERIOUSLY ILL/INJURED (VSI/SI) DURING MILITARY SERVICE

FORMER PRISONER OF WAR (Provide date(s) of confinement) (MM-DD-YYYY)

TO

TO

FROM

FROM

VETERAN'S SSN

SECTION IV - REPORT OF MEDICAL TREATMENT (If applicable)

18. LIST VA MEDICAL CENTERS (VAMC), DEPARTMENT OF DEFENSE (DoD) MILITARY TREATMENT FACILITIES (MTF), OR PRIVATE MEDICAL FACILITIES WHERE YOU WERE TREATED FOR THE CIRCUMSTANCE YOU IDENTIFIED IN ITEM 17 AND

PROVIDE APPROXIMATE BEGINNING DATE OF TREATMENT:

NAME/LOCATION OF TREATMENT FACILITY

Country State/Province

City

DATE OF TREATMENT (MM-DD-YYYY)

NAME/LOCATION OF TREATMENT FACILITY

Country State/Province

City

DATE OF TREATMENT (MM-DD-YYYY)

NAME/LOCATION OF TREATMENT FACILITY

Country State/Province

City

DATE OF TREATMENT (MM-DD-YYYY)

NAME/LOCATION OF TREATMENT FACILITY

Country State/Province

City

DATE OF TREATMENT (MM-DD-YYYY)

VA Form 20-10207, APR 2020 PAGE 5

VETERAN'S SSN

18A.SIGNATURE OF REQUESTER (REQUIRED) (Note: During COVID-19 ink and electronic signatures are accepted)

18B. DATE SIGNED (MM-DD-YYYY)

I CERTIFY THAT I have completed this form and it is true and correct to the best of my knowledge and belief.

SECTION V - CERTIFICATION AND SIGNATURE

SECTION VI - THIRD PARTY SIGNATURE (Only required if requester has an authorized third party)

I CERTIFY THAT the veteran/claimant has authorized me as the undersigned representative and certifies that the information contained in this document is

true and complete to the best of the veteran/claimant's knowledge.

NOTE: A third-party signature will not be accepted unless a valid VA Form 21-0845, Authorization to Disclose Personal Information to a Third-Party, is of

record or attached to this request. A third-party may be a family member or other designated person who is not a Power of Attorney, agent, or fiduciary. 

19A. THIRD-PARTY SIGNATURE (Note: During COVID-19 ink and electronic signatures are accepted)

19B. DATE SIGNED (MM-DD-YYYY)

SECTION VII - POWER OF ATTORNEY (POA) SIGNATURE (Required only if requester has an authorized POA representation)

I CERTIFY THAT the veteran/claimant has authorized me as the undersigned representative and certifies that the information contained in this document

is true and complete to the best of the veteran/claimant's knowledge.

NOTE: A POA's signature will not be accepted unless a valid VA Form 21-22, Appointment of Veterans Service Organization as Claimant's

Representative, or VA Form 21-22a, Appointment of Individual as Claimant's Representative, is of record or attached to this request.

20A. POWER OF ATTORNEY (POA) SIGNATURE (Note: During COVID-19 ink and electronic signatures are accepted)

20B. DATE SIGNED (MM-DD-YYYY)

RESPONDENT BURDEN: This information will let us help you in support of or response to your claim. Title 38, United States Code, allows us to ask for this information. It should take you about 7 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid Office of Management and Budget (OMB) control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.

PRIVACY ACT NOTICE: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 38, Code of Federal Regulations, 1.576 for routine uses (i.e., civil or criminal law enforcement, congressional communications, epidemiological or research studies, the collection of money owed to the United States, litigation in which the United States is a party or has an interest, the administration of VA programs and delivery of VA benefits, verification of identity and status, and personnel administration) as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records - VA, published in the Federal Register. Your obligation to respond is voluntary.

PENALTY: The law provides severe penalties (including fine and/or imprisonment) for willfully submitting any statement or evidence of a material fact you know to be

false, or for fraudulent receipt of any document you are not entitled to.